One military directive says civilian employees in theater should receive the same level of care given to military personnel, a GAO review of Defense guidelines on civilian medical care found. But military guidance for personnel in Iraq and Afghanistan says routine care for civilian employees should be offered only when possible. Another policy on care in Afghanistan sets a third standard, providing "emergency essential" civilian employees -- but not all civilian workers -- with the same health care access as military personnel.

The report found that the conflicting policies stymied officials allocating personnel in Iraq and Afghanistan because the type of medical care necessary was unclear.

Despite the inconsistencies, no civilian employees were denied routine medical care during GAO's 18-month investigation between August 2009 and January 2011, the watchdog said. But, the report warned, contradictory policies could result in civilian personnel being denied health care if the number of civilians in theater increases in the future.

The report refocuses debate on an issue that has received much congressional attention in the past. In 2007, the Armed Services Oversight and Investigations Subcommittee expressed concern over inconsistent medical treatment of Defense personnel in Iraq and Afghanistan.

Rep. Vic Snyder, D-Ark., and Rep. Todd Akin, R-Mo., the then-chairman and ranking member of the subcommittee, respectively, said in a joint statement at the time, "We are asking these civilians to face many of the same dangers as our troops face. They must be taken care of just as thoroughly."

But, in contrast to the new GAO report, the subcommittee focused largely on implementation issues affecting civilian medical care and found Defense policies largely adequate.

The finding was part of a broader GAO investigation into Defense's procedures for assessing medical personnel in war zones. Besides looking into medical access to civilian personnel, GAO examined how Defense allocates its medical units to best provide medical care. Commanders have reorganized and divided medical teams to better provide emergency service, GAO found, but said Defense should update its policy to reflect changes on the ground.

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